Texas health officials confident children's insurance program will be renewed

AUSTIN — Although Congress missed a crucial deadline last week to renew a health insurance program for low-income children, Texas health officials are confident that funding will be restored soon.

There are nearly 400,000 Texas children and pregnant women enrolled in the Children’s Health Insurance Program, or CHIP, which offers coverage to children from families who make too much money to qualify for Medicaid, but not enough to purchase private insurance.

“We’ve been watching the CHIP reauthorization issue very closely,” said Carrie Williams, spokeswoman for the Texas Health and Human Services Commission. “Indications are that it will be reauthorized, and we are hopeful for that.”

Congress failed to reauthorize funding for CHIP by Sept. 30, a missed deadline that means some states only have enough money to continue operating the program through December. Without new funding, Williams said, Texas’ existing federal allotment would be exhausted by February.

Texas would lose more than $1 billion in funding annually if no renewal bill is passed, according to a letter from a Health and Human Services official to members of the Children’s Health Coverage Coalition — a group that advocates for health coverage for children.

“HHS believes CHIP is a critical part of the health care safety net in Texas,” wrote Cecile Erwin Young, chief deputy executive commissioner at HHS. “CHIP has a proven track record of success, stemming from its adherence to the fundamental principles of state administrative flexibility, personal responsibility and innovation aimed at enhancing health outcomes for beneficiaries.”

The federal government covers most of the cost of the program, but some legislation being considered would return the program's federal matching rate to the standard level — phasing out a 23 percent bump approved in 2015. This would lead to a loss of $800 million in federal funding over the next two years, according to the commission.

The coalition — which includes the Texas Medical Association, the Texas Organizing Project and other groups — sent a letter to the state in September, urging officials to advocate for continued CHIP funding from Congress.

“Without such funding, Texas children who rely on our CHIP program would face the scary proposition of being forced into the already-unstable individual marketplace where benefits are not customized for this population and higher cost sharing severely threatens a child’s access to health care services,” the letter reads. “Furthermore, many children would simply become uninsured and reverse our state’s significant progress in this area.”

CHIP offers health insurance to children younger than 18 and pregnant women of all ages who fit financial qualifications. To qualify for the program, the child must be a citizen or a legal permanent resident — a parent’s immigration status does not factor into eligibility for the program.

The program seeks to cover children in families that have incomes above the threshold for Medicaid eligibility but don’t have coverage through their employer or can’t afford private coverage. A family of four in Texas qualifies for Medicaid if their monthly income is $2,727 or less and qualifies for CHIP if their monthly income is $4,121 or less.

Families enrolled are typically charged a $50 annual fee and their co-pay for doctor visits could range from $5 to $35, depending on their income.

Children enrolled in Texas are typically covered for dental and eye care in addition to primary care physicians, hospital services and treatment for pre-existing conditions.

“CHIP is a safety net program, and I’m telling this to you working at a safety net clinic,” said Dr. Pritesh Gandhi, associate chief medical officer at the People’s Community Clinic in Austin. “They are the only net for these patients. When these patients can’t access medical services through CHIP, they often access medical services through the emergency room.”

Gandhi said the program is vital to Texas because it supports working families who are investing in their community and trying to support their families.

“Without CHIP, all of the medical implications of poverty are magnified and CHIP proves to be a deterrent,” he said, adding that living in poverty can put children at risk for chronic diseases and increased stress, which can have an adverse impact on health.

In Texas, one in four children live in poverty, according to a 2016 report from the Center for Public Policy Priorities. The same report found that poverty rates for Latino and black children are almost three times higher than for white and Asian children.

To qualify for CHIP, a family’s income must be below 200 percent of the federal poverty level. There were 399,026 children and pregnant women enrolled in the program as of June, according to the latest available data from the Health and Human Services Commission.

“We don’t expect any kind of disruption in coverage anytime soon for those kids,” said Anne Dunkelberg, associate director of the Center for Public Policy Priorities and a former program director for Texas Medicaid. “Texas has not formally laid out what its plan would be yet, so I think we’re very hopeful Congress is going to get it together and get this funding extended sooner rather than later.”

Frank Dominguez, president and chief executive officer of El Paso Health, said the total number of children insured in the El Paso area is about 15,000. About 10,000 are insured through El Paso Health.

“For the most part, they’re going to be your children with parents that work but that don’t really have the funds to afford private insurance or work insurance,” he said. “They’re working class; they’re trying to make sure that their kids have insurance.”

While Dominguez is “pretty confident” Congress will find a solution, he said he has been in close contact with state officials and expects a “smooth transition” if the program does have to end.

“We feel confident that something will get resolved,” he said. “We do feel the government will do the right thing.”

Without CHIP, families could end up uninsured, said Estela Reyes, spokeswoman for Centro De Salud Familiar La Fe, an organization that operates several clinics in El Paso.

"We're looking at a situation where they're very likely going to have to look for health care for their children (while) uninsured, and that's not a good place to be for families here in our community, many of whom are very low income, who are trying very hard week by week to get by," she said.

Stacy Wilson, president of the Children’s Hospital Association of Texas, said she is hopeful funding will be restored, but until then, her concern is for families affected by Hurricane Harvey.

“While Texas is lucky enough to have a few months of funding that remains in the program, it’s such uncertainty for our families and the children that get access to this coverage,” she said. “Having some kind of stability, which this extension would do, would be greatly appreciated — especially in Harvey.”

In response to Harvey, Texas health officials waived all co-payments for services covered by CHIP and enrollment fees through November. The Texas Health and Human Services Commission will ask for federal emergency money to compensate providers, according to a fact sheet from the commission.

Maria Davila spends her days helping families register for CHIP, Medicaid and other state and federal programs through the Amistad Community Health Center in Corpus Christi. The center predominately services low-income communities and immigrant families, Davila said.

“If the program does end, it’s going to be a big issue for Texas,” she said. “We have a pretty bad situation because of the hurricane. If this happens, it’s going to be really, really bad for our patients and families around here and in Houston as well. We have a pretty big number of low-income families that depend on CHIP.”

Madlin Mekelburg is a reporter with the USA Today Austin Bureau; she may be reached at 512-479-6606; mmekelburg@elpasotimes.com; @madlinmek on Twitter.